NATIONAL HEALTH POLICY, SUSTAINABLE

DEVELOP,EMT GOALS, HEALTH INDICATOR

 INTRODUCTION:

• The national health policy was formulated by the union ministry of

health and welfare.
• The govt. of India adopt a national health program in 1983.
• The govt. of India evolved a national health policy in 1983 till 2002.
• After that a revised health policy for achieving better health care and
unmet goals has been brought by govt. of India – national health policy
2002.
• On 2017 , a union cabinet chaired byprime minister shri Narendra
Modi in its meeting on 15/3/17 has approved the national health policy
on 2017 i,e NHP 2017.
 DEFINITIONS:

1) Health : health is a state of complete physical, mental, and social

wellbeing and not merely the absence of disease or infirmity.
2) Policy: policy is a system , which provide a logical framework
and rationality of decision making for the achievement.
3) Health policy: health policy of a nation in its strategy for
controlling and optimizing the social use of its health knowledge
of intended objectives.
 NATIONAL HEALTH POLICY 1983-2002

• The ministry of health and family welfare govt. of India evolved a

national health policy in 1983 till 2002. the policy lays stress on
preventive , promotive, public health and rehabilitation aspects of
healthcare.
• It is the first India national health policy i,e years after
independence . The policy stress the need of establishing
comprehensive primary health care services to reach population in
the remote area of the country.
 OBJECTIVES OF THE POLICY

• A phase time bound program for setting up a well disperse network

of comprehensive primary health care services.
• Intermediation through ‘health volunteers’ having appropriate
knowledge, simple skills and requisite technologies.
• Establishment of well worked out referral system .
 NATIONAL HEALTH POLICY 2002-2017

• A revised health policy for achieving better health care and unmet
goals has been brought out by govt. of India – national health
policy 2002.
 Objective and key strategy of NHP 2002

• Primary health care approach

• Decentralized public health system
• Convergence of all health program under single field umbrella.
• Strengthening and extending public health services
• Enhanced contribution of private and NGO sector in health care delivery.
• Increase in public spending for health care
 NATIONAL HEALTH POLICY 2017-2030

• Now 14 years after the last health policy , the context has changed
in four major ways
• Firstly, the health priorities
are changing , although maternal and
child mortality have rapidly declined, there is growing burden on
account of non-communicable disease and some infectious
disease.
• The second important change is the emergence of a robust healthcare
industry estimated to be growing at double digit.
• The third change is the growing incidence of catastrophic expenditure
due to health care costs, which are presently estimated to be one of the
major contributions to poverty.
• Fourth, a rising economic growth enables enhanced fiscal capacity.
Therefore, a new health policy responsive to these contextual changes
is required.
 AIMS OF NHP 2017

• The primary aim of NHP 2017is to inform, clarify, strengthen and

prioritize the role of the govt. in shaping health systems in all its
dimension-investments in health, organization of healthcare
services, prevention of disease and promotion of good health
through cross sectoral actions.
• Access to technologies, developing human resources, encouraging
medical pluralism, building knowledge base, developing human
resources, encouraging/developing better financial protection strategies,
strengthening regulation and health assurance.
 OBJECTIVES

Specific quantitative goals and objectives:

The indicative , quantitative goals and objectives are outlined under three
broad components
i. Health status and program impact
ii. Health system performance and
iii.Health system strengthening
i. Health status and program impact
a. Life expectancy and healthy life:
• Increase life expectancy at birth from 67.5 to 70 by 2025.
• Establish regular tracking of disability adjusted life years
(DALY)index as a measure of burden of disease and its trend by major
categories by 2022.
b. Mortality by age and or cause
• Reduce under 5 mortality to 23 by 2025 and
• MMR from current levels to 100 by 2020
• Reduce infant mortality rate to 28 by 2019
• Reduce neo-natal mortality to 16 and still-birth rate to single digit by
2025.
c. Reduction of disease prevalence incidence
• Achieve global target of 2020 which is also termed as target of 90:90:90
for HIV/AIDS i,e 90% of all people living with HIV know heir HIV
status , 90%of all the HIV infected receive sustain anti-retroviral
therapy and 90% of all people receiving antiretroviral therapy will have
viral suppression.
• Achieve and maintain elimination status of leprosy by 2018 , kala – azar
by 2017 and lymphatic filariasis in endemic pockets by 2017.
• To achieve and maintain a cure rate of >85% in new sputum positive
patient for Tb and reduce incidence of new cases , to reach elimination
status by 2025.
• To reduce prevalence of blindness to 0.25/1000 by 2025 and disease
burden by one third from current levels.
• To reduce mortality from cardiovascular disease cancer, diabetes, pr
chronic respiratory distress by 255 by 2025.
ii. Health system performance
a. Coverage of health services
• Increase utilization of public health facilities by 50% from current
levels by 2025.
• Antenatal care coverage to be sustained above 90% and skilled
attendance at birth above 90% by 2025.
• More than 90% of the newborn are fully immunized by one year
of age by 2025.
• Meet need of family planning above 90% at national and sub-
national level by 2025.
• 80% of known hypertension and diabetic individuals at household
levels maintain controlled disease states by 2025.

b. Cross sectional goals related to health

• Relative reduction in prevalence of current tobacco use by 15% by
2020 and 30% by 2025.
• Reduction of 40% in prevalence of stunting of under 5 children by
2025.
• Access to safe water and sanitation to all by 2020 ( Swachh Bharat
Mission)
• Reduction of occupational injury by half from current levels of
334 per lakh agricultural workers by 2020.
• National / state level tracking of selected health behavior.
iii.Health system strengthening
a. Health finance
• Increase health expenditure by government as a percentage of
GDP from the existing 1.15% to 2.5% by 2025.
• Increase state sector health spending to >8% of their budget by
2020.
• Decrease in proportion of household facing catastrophic health
expenditure from the current levels by 25% by 2025.
b. Health infrastructure and health resource
• Ensure availability of paramedics and doctors as per Indian Public
Health Standards norm in high priority districts by 2020.
• Increase community health volunteers to population ratio as per
IPHS norm , in high priority district by 2025.
• Establish primary and secondary care facility as per norm in high
priority districts by 2025.
c. Health management information:
• Ensure district level electric database of information on health
system components by 2020.
• Strengthen the health survielliance system and establish registries
for disease of public health importance by 2020.
• Establish federated integrated health information architecture,
health information exchange and national health information
network by 2025.
 KEY POLICY PRINCIPLES:

1) Professionalism , integrity and ethics

The policy commits itself to the highest professional standard, integrity
and ethics to be maintained in the entire system of health care delivery in the
country, supported by a credible , transparent and responsible regulatory
environment.
2) Equity :
reducing inequity would mean affirmative actions to reach the poorest,
minimizing disparity in account of gender, poverty, caste, disability, other
forms of social education and geographical barriers.
3) Affordability :
as cost of care increase, the affordability, as distinct from equity,
requires emphasis catastrophic household healthcare expenditure
defined as health expenditure exceeding 10% of its total monthly
consumption expenditure or 40T% of its monthly non-food
consumption expenditure, including special groups.
4) Universality
Preventions of exclusions on social, economic or on grounds of
current health status. In this backdrop, system and services are
envisaged to be designed to cater to the entire population-including
special groups.

5) Patient centered and quality of care

Gender sensitive , effective, safe and convenient healthcare services
to be provided with dignity and confidentiality, there is need to evolve
system to ensure that the quality of health care is not compromised.
6) Accountability :
Financial and performance accountability, transparency in decision
making, and elimination of corruption in health care system, both in
public and private.
7) Inclusive partnership:
Patient who so choose and when appropriate , would have access
to AYUSH care providers based on documented and validated local,
home and community based practice.
8) Pluralism :
9) Decentralization :
Decentralization of decision making to a level in consistent with
practical considerations and institutional capacity. Community
participation in health planning process, to be promoted side by side.
10)Dynamics and adaptiveness:
Constantly improving dynamic organization of health care based on
new knowledge and evidence with learning from the communities and
from national and international knowledge partner is designed.
 POLICT THRUST

a. Ensuring adequate investment:

Policy proposed a potentially achievable target of raising public
health expenditure to 2.5% of the GDP in a time bound manner. It
envisage that the resource allocation to states will be linked with state
developmental indicators, absorptive capacity and financial indicators.
b. Preventive and promotive:
• The SWACHH Bharat Abhiyaan.
• Balanced, healthy diet and regular exercise.
• Addressing tobacco, alcohol and substabce use.
• Yatri Suraksha-preventing deaths due to rail and road traffic
accidents.
• Nirbhaya Nari-action against gender violence.
• Reduced stress and improve safety in the workplace.
• Reducing indoor and outdoor pollution.
c. Organization of public health care delivery:
• In primary care-from selective care to assured comprehensive care
with linkage to referral hospitals.
• In secondary and tertiary care-from an input oriented to an output
based strategies purchasing.
• In public hospitals-from user fees and cost recovery to assured free
drugs, diagnostic and emergency service to all.
• In infrastructure and human resource development-from normative
approach to target approach to reach under serviced area.
• In urban health-from taken interventions to on scale assured
intervention, to organized primary care delivery and referral for urban
poor.
• In national health program-integration with health system for program
effectiveness and in turn contributing to strengthening pf health
system for efficacy.
• In AYUSH services-from stand alone to a three dimensional
mainstreaming.
i. Primary care services:
• It focused on comprehensive primary health care
• It includes geriatric health care , palliative care and rehabilitative
care services.
• The facilities which start providing the larger package of
comprehensive primary health care will be called ‘health and
wellness centre’
ii. Secondary care services:
• In secondary care , the policy aims to achieve to have atleast two beds
per thousand population to be accessible within the golden hour rule.
• Resource allocation that is responsive to quantity, diversity and quality
of caseloads provided.
• Purchasing care after due diligence from non-government hospitals as
a short term strategy till public system are strengthening.
iii.Re-orienting public hospitals:
• Public hospitals have to be viewed as a part of tax finance single
payer health care system, where the care is pre-paid and cost efficient.
• The policy endorses that the public hospitals would provide universal
access to a progressively wide array of free drugs and diagnostic with
a suitable way to the state to suit their context.
• The policy seeks to eliminate the risks of inappropriate treatment by
maintaining adequate standard of diagnosis and treatment.
iv. Closing infrastructure and human resource/skill gaps:
• The policy duly acknowledge the roadmap of the 12 fifth year plan
th

for managing human resource for health. The policy initiatives aim
for measurable improvements in quality of care.
• Districts and blocks which have wider gaps for development of
additional human resources would receive focus.
v. Urban health centre:
• National health policy prioritize addressing the primary health care
needs of the urban population with special focus on poor population
living in listed and unlisted slums.
• Which also include AYUSH utilization.
• Better secondary prevention as an integral pat of the urban health
strategy.
• Improved health seeking behaviour, influenced through capacity
building of the community based organization and establishment of an
appropriate referral mechanisms, were also the important component
of the health strategy.
 SERVICES DELIVERY

a. RMNCH+A services:
• Improving the maternal and child health and their survival are central
to the achievement of national health goals under the national health
mission(NHM). SDG goal 3 also includes the focus on reducing
maternal, newborn and child mortality.
• In order to comprehensively address factors affecting maternal and
child survival, the policy seeks to address the social determinants
through developmental action on all sectors.
b. Child and adolescent health:
• The policy endorse the national concensus on accelerated
achievement of neonatal mortality target (16) and single digit still
birth rate through improved home based and facility based
management of sick newborns.
• District hospitals must ensure screening and treatment of growth
related problems(birth defects, genetic disease ) and provide
palliative care for children.
• The scope of reproductive and sexual health should be expanded to
address the social determinants through developmental actions in all
sectors.
c. Interventions to address malnutrition and micronutrient deficiencies:
• Recognizing the problems of malnutrition n the country, the policy
declares that micronutrients deficiencies would be address through a
well planned strategy on micronutrient interventions.
• The present effort of iron folic acid supplementation, calcium
supplementation during pregnancy, iodized salt, zinc and ORS ,
vitamin A supplementation during and needs to be intensified and
increased.
d. Universal immunization:
• The focus will be on the success of mission INDRADHANUSH and
strengthen it.
e. Communicable disease:
• The policy recognize the interrelationship between communicable
disease control program and public health system strengthening.
• For integrated disease surveillance program, the policy advocates the
need for districts to responds to the communicable disease priorities
of their locality.
• This could be through network of well-equipped laboratories booked
by tertiary care centres and enhanced public health capacity to collect,
analyze and respond to the disease outbreak.
f. Control HIV/AIDS
• The policy recommends focused intervention on high risk
communities(MSM, transgender, FSW etc) and prioritize geographies.
• There is a need to support care and treatment for people living with
HIV/AIDS through inclusion of 1st 2nd and 3rd line antiretroviral, Hep
C and other costly drugs into the essential medical list.
g. Control of tuberculosis:
• The policy co-acknowledge HIV nd Tb co-infection and increase
incidence of drug resistant tb as a key challenge in tuberculosis , the
policy calls for more active case detection , with a greater
involvement of private sector supplemented by preventive and
promotive action in the workplace.
• Access to free drug would need to be complimented by affirmative
action to ensure that the treatment is carried out , dropout reduced and
transmission of resistant strain are contained.
h. Leprosy elimination:
• Keeping in mind the global goal of reduction of grade 2 disability due
to leprosy to less than 1 per million by 2020, the policy envisages
practice measures target towards elimination of leprosy from India by
2018.
i. Vector borne disease control:
• New national program for prevention and control of JE/acute
encephalitis syndrome should be accelarated with strong component
of inter-sectoral collaboration.
j. Non-communicable disease:
• Emphasis on medication and access for select chronic illness on a
‘round the year’ basis would be assured.
• screening for oral , breast and cervical cancer and for COPD disease
will be focused in addition to hypertension and diabetes.
• The policy focused is also on research. It emphasis developing
protocol for mainstreaming AYUSH at an integrated medical care.
• Further the policy commits itself to support programmes for
prevention of blindness , deafness , oral health, endemic diseases like
fluorosis and sickle cell anemic/thalassemia etc.
k. Mental health:
• This policy will take into consideration the provision of the national
mental health policy 2014with simultaneous action on the following
fronts.
• Increase creation of specialist through public financing and develop
special rules to give preference to those willing to work in public
system.
• Create network of community members to provide psycho-social
support to strengthen mental health services at primary level facilities
and
• Leverage digital technology in a central where access to qualified
psychiatrist in difficult.
l. Population stabilization :
• The policy imperative is to move away from camp based services
with all its attendance problems of quality, safety and dignity of
women, to a situation , where these services are available on any day
of the week or at least on a fixed day.
m.Women’s health and gender mainstreaming:
• There will be enhanced provision for reproduction morbidities and
health needs of woman beyond the reproductive age group (40+). This
would be in addition to package of services covered in the previous
paragraphs.

n. Gender based violence:

• Women’s access healthcare needs to be strengthens bu making public
hospitals more women friendly and ensuring that the staff have
orientations to gender-sensitivity issues.
o. Supportive supervision:
• For supportive supervision in more vulnerable districts with
inadequate capacity, the policy will support innovative measure such
as use of digital tool and HR strategies like using nurse trainees to
support field workers.
p. Emergency care and disaster preparedness:
• The policy supports the development of earthquake and cyclone
resistant health infrastructure in vulnerable geographies.
• To respond to disaster and emergencies, the public health care system
needs to be adequately skilled and equipped at defined level, so as to
respond effectively during emergencies.
• The policy envisages creation of a unified emergency response system
, linked to a dedicated universal access number, with network of
emergency care that has an assured provision of life support
ambulance , trauma management centres.
• 1 per 30 lakh population in urban
• 1 for every 10 lakh population in rural
q. Mainstreaming the potential of AYUSH:
• The policy recognize needs to nurture AYUSH system od medicine
through development of infrastructure facilities of teaching
institutions, improving quality control of drugs.
r. Tertiary care service:
• The policy recommends that the government should set up new
medical colleges , nursing institutions and AIIMS in the country
following the broad principle.
s. Collaboration with non-government sectoral engagement with
private sector:
The policy suggest exploring collaboration for primary care services
with ‘not for profit’ organization having a track record of public
services where critical gaps exist, as a short term measure.

t. Food safety:
• The policy recommends putting in place and strengthening necessary
network of office, laboratories, e-governance structure and human
resources needed for the enforcement of food safety and standard act
2006.
MILLENIUM DEVELOPMENT GOALS
The MDG called for the action to:
• Eradicate extreme poverty and hunger
• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health
• Combat HIV/AIDS, malaria and other diseases
• Ensure environmental sustainability and
• Develop a global partnership for development
• Progress towards MDG has on the whole, been remarkable. An under-
nourish people in developing countries or region has fallen from 235
in 1990-1992 to 13% in 2014-2016. the child under-nutriTion indicator
target has almost been met.
SDG GOALS
• In December 2015, the millennium development goals come to an end
and a post 2015 agenda comprising of 17 sustainable development
goals taken the place of MDG . Even though the progress towards the
MDGs has been impressive in many ways, there is much work remain
to be done. Agenda for sustainable development officially came into
force with the five Ps( people, planet, prosperity, peace and
partnership)
Definition :
The sustainable development has been defined as ‘development that
meet the needs of the planet without compromising the ability of future
generation to meet their own needs’.
• The 2020 agenda is designed to benefit all universal in scope, the
agenda will require a comprehensive, integrated approach to sustain
development, as well as collective action at all levels. ’leaving no one
behind ‘ will be an overarching theme.
• By 2030, eradicate extreme poverty for all
people everywhere, currently measured as
people living on less than $1.25 a day
• By 2030, reduce at least by half the proportion
of men, women and children of all ages living
in poverty in all its dimensions according to
national definitions
• Implement nationally appropriate social
protection systems and measures for all,
including floors, and by 2030 achieve
substantial coverage of the poor and the
vulnerable
• By 2030, end hunger and ensure access by all
people, in particular the poor and people in
vulnerable situations, including infants, to safe,
nutritious and sufficient food all year round.
• By 2030, end all forms of malnutrition, including
achieving, by 2025, the internationally agreed targets
on stunting and wasting in children under 5 years of
age, and address the nutritional needs of adolescent
girls, pregnant and lactating women and older
persons.
• By 2030, double the agricultural productivity and
incomes of small-scale food producers, in particular
women, indigenous peoples, family farmers,
pastoralists and fishers, markets and opportunities for
value addition and non-farm employment.
• By 2030, reduce the global maternal mortality ratio to
less than 70 per 100,000 live births.
• By 2030, end preventable deaths of newborns and
children under 5 years of age, with all countries aiming
to reduce neonatal mortality to at least as low as 12 per
1,000 live births and under-5 mortality to at least as low
as 25 per 1,000 live births.
• By 2030, end the epidemics of AIDS, tuberculosis,
malaria and neglected tropical diseases and combat
hepatitis, water-borne diseases and other communicable
diseases.
• By 2030, reduce by one third premature mortality from
non-communicable diseases through prevention and
treatment and promote mental health and well-being.
• By 2030, ensure that all girls and boys
complete free, equitable and quality primary
and secondary education leading to relevant
and Goal-4 effective learning outcomes
• By 2030, ensure that all girls and boys have
access to quality early childhood
development, care and preprimary education
so that they are ready for primary education
• By 2030, ensure equal access for all women
and men to affordable and quality technical,
vocational and tertiary education, including
university
• By 2030, substantially increase the number
of youth and adults who have relevant skills,
including technical and vocational skills, for
employment, decent jobs and
• By 2030, eliminate gender disparities in education and ensure equal access to all
levels of education and vocational training for the vulnerable, including persons with
disabilities, indigenous peoples and children in vulnerable situations
• By 2030, ensure that all youth and a substantial proportion of adults, both men and
women, achieve literacy and numeracy
• Eliminate all harmful practices, such as
child, early and forced marriage and
female genital mutilation
• Eliminate all forms of violence against
all women and girls in the public and
private spheres, including trafficking and
sexual and other types of exploitation
• Ensure women’s full and effective
participation and equal opportunities for
leadership at all levels of
decisionmaking in political, economic
and public life
• Enhance the use of enabling technology,
in particular information and
communications technology, to promote
the empowerment of women
• End all forms of discrimination against all women and girls everywhere
• Recognize and value unpaid care and domestic work through the provision of
public services, infrastructure and social protection policies and the promotion of
shared responsibility within the household and the family as nationally
appropriate
• Adopt and strengthen sound policies and enforceable legislation for the
promotion of gender equality and the empowerment of all women and girls at all
levels
• By 2030, ensure universal access to affordable, reliable and modern
energy services
• By 2030, increase substantially the share of renewable energy in the global
energy mix
• By 2030, double the global rate of improvement in energy efficiency
• By 2030, enhance international cooperation to facilitate access to clean
energy research and technology, including renewable energy, energy
efficiency and advanced and cleaner fossil-fuel technology, and promote
investment in energy infrastructure and clean energy technology
• By 2030, expand infrastructure and upgrade technology for supplying
modern and sustainable energy services for all in developing countries, in
particular least developed countries, small island developing States, and
land-locked developing countries, in accordance with their respective
programmes of support
• Sustain per capita economic growth
in accordance with national
circumstances and, in particular, at
least 7 per cent gross domestic
product growth per annum in the
least developed countries
• Achieve higher levels of economic
productivity through diversification,
technological upgrading and
innovation, including through a
focus on high-value added and
labour-intensive sectors
• Promote development-oriented policies that support productive
activities, decent job creation, entrepreneurship, creativity and
innovation, and encourage the formalization and growth of micro-,
small- and medium-sized enterprises, including through access to
financial services
• By 2030, achieve full and productive employment and decent work
for all women and men, including for young people and persons with
disabilities, and equal pay for work of equal value
• By 2020, substantially reduce the proportion of youth not in
employment, education or training
• Develop quality, reliable,
sustainable and resilient
infrastructure, including regional and
transborder infrastructure, to support
economic development and human
well-being, with a focus on
affordable and equitable access for
all
• Promote inclusive and sustainable
industrialization and, by 2030,
significantly raise industry’s share of
employment and gross domestic
product, in line with national
circumstances, and double its share
in least developed countries
• By 2030, progressively achieve and
sustain income growth of the
bottom 40 per cent of the population
at a rate higher than the national
average
• By 2030, empower and promote the
social, economic and political
inclusion of all, irrespective of age,
sex, disability, race, ethnicity,
origin, religion or economic or other
status
• By 2030, reduce to less than 3 per cent the transaction costs of
migrant remittances and eliminate remittance corridors with costs
higher than 5 per cent
• By 2030, ensure access for all to
adequate, safe and affordable housing
and basic services and upgrade slums
• Strengthen efforts to protect and
safeguard the world’s cultural and
natural heritage
• By 2030, provide access to safe, affordable, accessible and
sustainable transport systems for all, improving road safety, notably
by expanding public transport, with special attention to the needs of
those in vulnerable situations, women, children, persons with
disabilities and older persons
• By 2030, significantly reduce the number of deaths and the number
of people affected and substantially decrease the direct economic
losses relative to global gross domestic product caused by disasters,
including water-related disasters, with a focus on protecting the poor
and people in vulnerable situations
• By 2030, achieve the sustainable
management and efficient use of
natural resources
• By 2030, halve per capita global
food waste at the retail and
consumer levels and reduce food
losses along production and supply
chains, including post-harvest losses
• By 2020, achieve the environmentally sound management of
chemicals and all wastes throughout their life cycle, in accordance with
agreed international frameworks, and significantly reduce their release
to air, water and soil in order to minimize their adverse impacts on
human health and the environment
• By 2030, substantially reduce waste generation through prevention,
reduction, recycling and reuse
• Encourage companies, especially large and transnational companies,
to adopt sustainable practices and to integrate sustainability
information into their reporting cycle
• By 2030, ensure that people everywhere have the relevant information
and awareness for sustainable development and lifestyles in harmony
with nature
• Strengthen resilience and adaptive
capacity to climate-related hazards
and natural disasters in all countries
• Integrate climate change measures
into national policies, strategies and
planning
• Improve education, awareness-
raising and human and institutional
capacity on climate change
mitigation, adaptation, impact
reduction and early warning
• Promote mechanisms for raising capacity for effective climate
change-related planning and management in least developed countries
and small island developing States, including focusing on women,
youth and local and marginalized communities
• By 2025, prevent and significantly
reduce marine pollution of all
kinds, in particular from land-based
activities, including marine debris
and nutrient pollution
• By 2020, sustainably manage and
protect marine and coastal
ecosystems to avoid significant
adverse impacts, including by
strengthening their resilience, and
take action for their restoration in
order to achieve healthy and
productive oceans
• Minimize and address the impacts of ocean acidification, including
through enhanced scientific cooperation at all levels
• By 2020, effectively regulate harvesting and end overfishing, illegal,
unreported and unregulated fishing and destructive fishing practices
and implement science-based management plans, in order to restore
fish stocks in the shortest time feasible, at least to levels that can
produce maximum sustainable yield as determined by their biological
characteristics
• By 2020, conserve at least 10 per cent of coastal and marine areas,
consistent with national and international law and based on the best
available scientific information
• By 2020, promote the
implementation of sustainable
management of all types of forests,
halt deforestation, restore degraded
forests and substantially increase
afforestation and reforestation
globally
• By 2030, combat desertification,
restore degraded land and soil,
including land affected by
desertification, drought and floods,
and strive to achieve a land
degradation-neutral world
• By 2030, ensure the conservation of mountain ecosystems, including
their biodiversity, in order to enhance their capacity to provide benefits
that are essential for sustainable development
• Take urgent and significant action to reduce the degradation of natural
habitats, halt the loss of biodiversity and, by 2020, protect and prevent
the extinction of threatened species
• Promote fair and equitable sharing of the benefits arising from the
utilization of genetic resources and promote appropriate access to such
resources, as internationally agreed
• Take urgent action to end poaching and trafficking of protected
species of flora and fauna and address both demand and supply of
illegal wildlife products
• Significantly reduce all forms of
violence and related death rates
everywhere
• End abuse, exploitation, trafficking
and all forms of violence against and
torture of children
• Promote the rule of law at the
national and international levels and
ensure equal access to justice for all
• By 2030, significantly reduce illicit financial and arms flows, strengthen
the recovery and return of stolen assets and combat all forms of
organized crime
• Substantially reduce corruption and bribery in all their forms
• Develop effective, accountable and transparent institutions at all levels
• Ensure responsive, inclusive, participatory and representative decision-
making at all levels
• Broaden and strengthen the participation of developing countries in the
institutions of global governance
• By 2030, provide legal identity for all, including birth registration
 Finance
• Strengthen domestic resource
mobilization, including through
international support to developing
countries, to improve domestic capacity
for tax and other revenue collection
• Mobilize additional financial resources
for developing countries from multiple
sources
• Adopt and implement investment
promotion regimes for least developed
countries
• Technology
• Promote the development, transfer, dissemination and diffusion of
environmentally sound technologies to developing countries on
favourable terms, including on concessional and preferential terms, as
mutually agreed
• Fully operationalize the technology bank and science, technology and
innovation capacity-building mechanism for least developed countries
by 2017 and enhance the use of enabling technology, in particular
information and communications technology
 Capacity building
• Enhance international support for implementing effective and
targeted capacity-building in developing countries to support national
plans to implement all the sustainable development goals, including
through North-South, South-South and triangular cooperation
Trade
• Promote a universal, rules-based, open, non-discriminatory and
equitable multilateral trading system under the World Trade
Organization, including through the conclusion of negotiations under
its Doha Development Agenda
• Significantly increase the exports of developing countries, in
particular with a view to doubling the least developed countries’ share
of global exports by 2020
INDICATORS
HEALTH
• Indicators are only an indication of a given situation or a reflection of
that situation. Indicators help to maintain and measure the extent to
which the objectives and targets of a programme are being attained.
• In WHO guidelines for health programme evaluation, they are
defined as variables which help to measure changes. Often they are
used particularly when these changes cannot be measure directly as
for example: HEALTH.
Characteristics of indicators:
Indicators:
Special indicator services:
1. MORTALITY RATE INDICATORS

• Crude death rate:

It is defined as no. of death per 1000 population per year in a given
community. It indicates the rate at which people are dying.

• Expectation of life:
It is the average number of years that will be lived by those born alive
into a population if the current age specific mortality rates persists.
• AGE-SPECIFIC DEATH RATE is the total number of deaths to
residents of a specified age or age group in a specified geographic
area (country, state, county, etc.) divided by the population of the
same age or age group in the same geographic area (for a specified
time period, usually a calendar year) and multiplied by 100,000
Calculation:
Total Deaths in Specified Age Group/
Total Population in the Same Specified Age Group X 100,000
• Infant mortality rate:
Number of deaths among children < 1 year of age reported during a
given time period/Number of live births reported during the
same time period x 1000
The current infant mortality rate for India in 2023 is 26.619 deaths per
1000 live births, a 3.89% decline from 2022. The infant mortality rate for
India in 2022 was 27.695 deaths per 1000 live births, a 3.74% decline
from 2021
• Child death rate:
The number of infant mortality/the number of infants in mid-year × 100.
• Under five proportionate mortality rate:
It is the proportion of total death occurring with under 5 age group.
This rate can be used to reflect both infant and child mortality rate.
High rate reflects high mortality, high child mortality rate and shorter
life expectancy.
• Adult mortality rate;
It is defined as the probability of dying between the age of 15 and 60
years per 1000 population.
• Maternal mortality rate:
(Number of maternal deaths / Number of live births) X 100,000
Currently in 2023 the current MMR is 145
Assam has the highest maternal mortality rate (MMR) at 195,
followed by Madhya Pradesh at 173 and Uttar Pradesh at 167 (per
lakh live births
• Proportional mortality rate;
It is the proportion of all death currently attributed to it.
Eg: coronary heart disease is the cause of 25-30% of all death in most
western countries. It indicates the magnitude of preventable mortality.
• Disease specific rate:
It is the number of deaths from a specified cause per 100,000 person-
years at risk.
• Case fatality rate:
It is the proportion of people who die from a specified disease among
all individuals diagnosed with the disease over a certain period of time .
As an example, consider two populations. A population consists of
1,000 people; 300 of these people have the specified disease, 100 of
whom die from the disease. In this case, the mortality rate for the
disease is 100 ÷ 1,000 = 0.1, or 10 percent. The case fatality rate is 100
÷ 300 = 0.33, or 33 percent
• Years of potential life lost:
It is an estimate of the average years a person would have lived if they
had not died prematurely. It is, therefore, a measure of premature
mortality.

Subtracting the age at death from the standard year, and then summing
the individual YPLL across each cause of death.
For example, if three people died from a certain cause who were ages
2, 37, and 74, the YPLL-65 for that cause of death would be (65-
2)+(65-37))=63+28=91.
 MORBIDITY INDICATORS

• To describe the health in terms of mortality rate only is misleading

, the reason is that because, mortality indicators do not reveal the
burden of ill health in a community, as for example , mental illness
and rheumatoid arthritis .
• The morbidity rate have tend to overlook a large number of
conditions which are subclinical or inappropriate , that is the
hidden part of ice berg disease.
• Incidence:
The number of new case or new disease in a defined population , within
a specified period of time.
Eg: incidence of Tb in India is 176 per 100,000.

• Prevalence:
The total number of all individuals who have an attribute or disease at a
particular time divided by population at risk of having attributed or
disease at their point of time it reflects the chronicity of disease.
• Notification rate:
It is calculating from the reporting to public authorities of certain
diseases to public .
Eg: yellow fever , poliomyelitis
Attendance rate at the OPD and at health centres.
Admission, readmission and discharge rates.
• Disability rates:
1. Event type
Number of days of restricted activities
Bed disability days
Work loss days within a specified period
2. Person type indicators
Limitation of mobility( eg: confined to bed, confined to house)
Limitation of activity(limitation to perform basic ADL)
• Health-adjusted life expectancy
It is the number of years in full health that an individual can expect to
live given the current morbidity and mortality condition
This is calculated by subtracting from the life expectancy a figure
which is the number of years lived with disability multiplied by a
weighting to represent the effect of the disability.
• Quality adjusted life years:
It assumes that a year of life lived in perfect health is worth 1 QALY (1
Year of Life × 1 Utility = 1 QALY) and that a year of life lived in a
state of less than this perfect health is worth less than 1.

• Disability adjusted life years:

YLD is determined by the number of years disabled weighted by level
of disability caused by a disability or disease using the formula: YLD =
I × DW × L. where N = number of deaths due to condition, L =
standard life expectancy at age of death.
• Nutritional status indicator:
Anthropometric measurement( weight and height , mid arm circumference,
head circumference etc)
Prevalence of low birth weight < 2.5 kg

• Utilization rate:
YLD is determined by the number of years disabled weighted by level of
disability caused by a disability or disease using the formula: YLD = I × DW
× L. where N = number of deaths due to condition, L = standard life
expectancy at age of death.
YLD is determined by the number of years disabled weighted by level of
disability caused by a disability or disease using the formula: YLD = I × DW
× L. where N = number of deaths due to condition, L = standard life
expectancy at age of death.
OTHERS :
• Indicators of social and mental health
• Environmental indicators
• Socio-economic indicators
Rate of population increase
Per capita GNP
Level of unemployment
Depending ratio
Literacy rate
Family size
• Health policy indicators
Proportion of GNP spent on health services
• Health care delivery indicators
Doctor population ratio
Doctor – nurse ratio
Population bed ratio
Population per trained health attendant rate
• Indicators of quality of life
IMR, life expectancy rate
• Social indicators
• Basic needs indicators
• Special indicators